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Super Hero
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OK ... back to the topic. In cases like the one in question at the original post, I generally like to simplify the situation down to a little diagram or two. Think about the circuit(s) involved; the voltages, currents, and resistances - and what sort (magnitude) of values they are likely to be.

And then, with "active" kit like ESU's, think for a moment about the power being dished out, its frequency and wave-shape(s), and its duration ... then ask yourself questions like:- "where does all that energy go" (where is it dissipated), and - importantly - what good does it do (as far as the patient is concerned)?

Such an approach works when thinking about all kinds of kit; ESU's, defibs, x-ray, active physio stuff ... you name it. smile

Lastly (let's hope), in the case of two ESU's acting on the same body mass, I would suggest that each ESU effectively has its own little circuit:- ESU -> active electrode -> body -> return plate -> back to the ESU. In a carefully (properly) arranged set-up, any interaction between the two ESU's is going to be negligible (if any), I would have thought.

In fact it would be interesting to find out how close each pair of active electrodes and return plates would need to be to each other before any noticeable (measurable) interference actually occurred (and before any of the alarms on the ESU's started sounding). A bit of "RF blending" of the waveforms - and therefore possible unexpected results at the sharp end - would be my guess (especially if the ESU's were being used in different modes). Would anyone (the surgeons, for example) notice? And, if they did (and become worried by it all), why not simply take it in turns to "blaze away"!

Anyway, there's a nice little PhD project for someone there! whistle

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Philosopher
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Hello

Can I suggest the easiest solution would be using something like Eschmann's TD850 Electrosurgery Unit which according to the literature

"A unique feature of the TD850 is that all three generators can be used simultaneously in either cut or coagulation modes, so up to three surgeons can operate at the same time."

Lee


Don't forget "we've never had it so good".
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Super Hero
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OK Lee ... now you've opened up another can of worms! smile

What's the "unique feature"? think

And ... what is the TD-850; a three channel ESU?

One machine with three outputs ... or three machines (and why only three)? And how many return plates?

OK. Let's check out the spec.

And here's a new one (for me at least):-

Quote:

Leakage Currents

Patient leakage (MSK) current: typically 10 microamps in single fault condition. Typically less that 1 microamp in normal condition.


MSK? What's that all about? think

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Scholar
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Originally Posted By: Geoff Hannis
Which currents were your local expert thinking of there, I wonder? think

I never got that out of him. Perhaps he was thinking of the earth-referenced units RoJo mentioned?

Personally speaking, I would agree that any unintended currents are likely to be extremely low. Current from the pencil to the 'wrong' return pad must surely be minimal, assuming proper placement and skin prep, and unless the surgeon is waving an active pencil around in the air then RF leakage is bound to be pretty low too.

Regarding the TD850, it has two monopolar outputs and a bipolar output. Same as most competitors. But on certain other units (e.g. Valleylab Force FX) during simulataneous monopolar coag the power is divided between the two outputs according to the relative resistances (ohm's law again), and on that particular unit simultaneous cut is not possible.
The TD850, judging by the documentation, has separate transformers for each monopolar output and therefore can deliver the full power to both.

The downside is that both monopolar outputs share a common return pad, therefore it is only suitable in cases where both operating sites are close enough that the one pad provides a suitable placement for both of them.

Edit: MSK = ...musculoskeletal?

Last edited by Gordovan; 17/10/13 3:23 PM.

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Super Hero
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Earth-referenced or floating output ... would (does) it make much difference (to "spurious currents"), I wonder? think

OK, so the "unique feature" is having two (not three, then) independent monopolar outputs (which is probably why it appears so bulky). But sharing a return pad (plate) doesn't sound like Good News to me. Unless, that is, the two active fields are so close together that it doesn't make any difference.

As you have mentioned, there has to be a separation (distance between the two active sites) consideration here. So what is it, I wonder? And what happens if it gets overlooked (forgotten, or ignored)? Maybe it's that scenario that your taciturn expert was getting at! frown

Meanwhile:- MSK ... the plot thickens! whistle

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Most modern diathermies (ESU's) have isolated outputs so all the current coming out of one generator will only go back into the same generator, there should be no path to earth. So unless you wrap the active lead of second ESU round the patient and turn them into am oversized transformer, there shouldn't be any current passed from one to the other. HF & LF leakage currents may be available but as mentioned before will be very small. If some of the current goes AWOL the ESU should detect an imbalance and cut-out.

One risk factor with two operating sites is the risk of fire! It is possible that while one team is cleaning up the other is still blasting away, vapours or splashes could be ignited by the second diathermy.

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Super Hero
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Frank has a collection of useful stuff about ESU Principles and Testing. smile

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Many thanks for all the replies.

Received the following feedback from the company:
"Many thanks for your communication regarding the use of two systems simultaneously. This will not be an issue if you follow the same guidance that you would with one system. As each operates in a closed circuit please make sure that the pad is placed closely to the surgical site as you would do normally.

This will ensure that the procedure can be carried out safely."

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